epicondylitis

Epicondylitis is a common elbow condition arising from overuse of the forearm muscles and their tendinous origins at the elbow. The term encompasses two main forms: lateral epicondylitis (often called tennis elbow) from degeneration of the extensor tendon origins at the lateral epicondyle, and medial epicondylitis (often called golfer’s elbow) from similar changes in the flexor-pronator tendon origins at the medial epicondyle. The condition is now understood as a tendinopathy rather than an acute inflammatory condition.

Causes and risk factors include repetitive wrist extension or flexion, forceful forearm movements, and occupations or activities involving repetitive arm use. Most cases occur in adults aged 30 to 50, but they can affect people in any age group. Symptoms typically include localized pain and tenderness at the involved epicondyle, worsened by gripping, wrist extension, or forearm rotation; there may be grip weakness or forearm stiffness.

Diagnosis is clinical, based on history and exam, with provocative tests such as Cozen’s test, Mills test, or Maudsley test supporting the diagnosis. Imaging is not routinely required but may be used to exclude other pathology or assess tendon degeneration; ultrasound or MRI can show tendinopathy or tears. X-rays are usually normal but may rule out other conditions.

Treatment is usually conservative. Central components include activity modification and rest, nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy emphasizing eccentric strengthening and stretching of the forearm muscles. Bracing or counterforce bands can help. Corticosteroid injections may provide short-term relief but are not preferred due to higher recurrence risk; options such as shock wave therapy or platelet-rich plasma are variably effective. Surgery is considered only for persistent cases after several months of failed conservative therapy, typically involving debridement or release of the affected tendon. Prognosis is generally good with appropriate rehab, though symptoms can recur. Prevention emphasizes proper technique, conditioning, and gradual progression of activity.